According to SingHealth, in Asia, diabetic retinopathy (DR) is the primary cause of visual loss. With 10% of Singaporean individuals between the ages of 18 and 69 having diabetes, Singapore has one of the highest prevalence rates of diabetes mellitus (DM) in the world. Around 30% of these people have DR, with 10% having vision-threatening DR.
What is diabetic retinopathy?
The most common type of diabetic eye disease is diabetic retinopathy. It is a consequence of diabetes that damages the back of the eye due to excessive blood sugar levels (retina). If left misdiagnosed and untreated, it might result in blindness.
Diabetic retinopathy includes two stages:
- non-proliferative diabetic retinopathy (NPDR): Increased vascular permeability and capillary occlusion are two key findings in the retinal vasculature in NPDR, which characterizes the early stage of DR. The retina’s blood vessel walls weaken and expand, generating small pouches. These pouches can leak blood and other fluid, causing the macula (a portion of the retina) to expand and distort your vision (macular edema). In persons with diabetic retinopathy, macular edema is the most prevalent cause of blindness. Macular edema affects around 50% of diabetic retinopathy patients.
- proliferative diabetic retinopathy (PDR): PDR is characterized by neovascularization, which is a more advanced stage of DR. When the new aberrant arteries flow into the vitreous (vitreous hemorrhage) or when tractional retinal detachment is occurring, the patients may have a significant visual impairment.
Long-term elevated blood glucose levels induce diabetic retinopathy. High sugar glucose levels in the retina can weaken and destroy tiny blood vessels over time. This can result in retinal hemorrhages, exudates, and even edema. As a result, the retina is deprived of oxygen, and aberrant vessels may form.
Diabetic retinopathy can affect everyone who has diabetes. However, the following factors might enhance your chances of having the condition:
- Having diabetes for several years
- Your blood sugar level is out of control.
- Blood pressure problems
- Tobacco use
- Being pregnant
- High cholesterol
In the early stages of diabetic retinopathy, you may not notice any symptoms. As the illness worsens, you may experience:
- Blurred vision
- Vision loss
- Eye pain
- Dark shapes or spots in your eyesight (floaters)
Fluorescein angiography involves injecting a yellow dye called fluorescein into a vein. The color is absorbed by your blood vessels. Then the dye flows through the retina’s blood vessels, a unique camera captures pictures of it. When any blood vessels are clogged or leaking fluid, this will be visible. Moreover, it also reveals whether any abnormal blood vessels are developing.
Optical coherence tomography (OCT)
OCT angiography is a modern technology that examines blood arteries without the use of dye. Your doctor may use an OCT scan to examine your retina more precisely. The retina is scanned by a machine, which produces detailed pictures of its thickness. This helps your doctor in locating and measuring macula edema.
The anti-VEGF drug is one sort of treatment. Avastin, Eylea, and Lucentis are among them. Anti-VEGF therapy reduces macula swelling, which slows vision loss and may even improve eyesight. This medication is administered by eye injections (shots). Another method for reducing macular edema is a steroid medication. This can also be administered as an eye injection.
To assist shut off bleeding blood vessels, laser surgery may be utilized. This can help to minimize retinal edema. Blood vessels can be shrunk and prevented from developing again via laser surgery. Occasionally, more than one therapy is required. Several types of laser treatments include:
Photocoagulation: It has the ability to block or slow blood and fluid leaking in the eye. Laser burns are used to address leakage from aberrant blood vessels during the treatment.
Panretinal photocoagulation (PRP): PDR has also been treated using this method, which has been shown to lower the risk of severe vision loss, especially in instances with high-risk consequences such as vitreous hemorrhage. It has the ability to shrink aberrant blood vessels. The portions of the retina farthest from the macula are treated with dispersed laser burns during the process. The unusual new blood vessels shrink and scar as a result of the burns.
The pattern scanning laser (PASCAL): It’s a novel laser approach for treating PDR. It decreases laser-induced retinal damage by allowing for more accurate laser control and shorter treatment times. To simplify the delivery of subthreshold burns while minimizing collateral damage, micropulse methods such as the subthreshold micropulse diode laser (D-MPL) have been used. The use of a guided laser system (NAVILAS) has lately improved the precision of laser spots administered to the retina, resulting in better vision results.
When you get advanced PDR, your ophthalmologist may suggest vitrectomy surgery. Vitreous gel and blood from leaky vessels at the back of your eye are removed by an ophthalmologist. Light rays may now concentrate properly on the retina once again. The retina may also have scar tissue removed.
Control blood sugar level
High blood sugar affects blood vessels in the eyes over time, and it can also distort the shape of your lenses, blurring your vision. If you’re sick or stressed, you may need to check and record your blood sugar level multiple times a day. Consult your doctor about how frequently you should test your blood sugar.
Maintain healthy blood pressure and cholesterol level
To reduce your risk of eye problems and vision loss you should keep your blood pressure and cholesterol levels within your desired range by following healthy eating habits and regular exercise. Medication is another way for you to do this.
Smoking raises your chances of developing diabetes problems including diabetic retinopathy. Therefore, quitting smoking decreases your risk of diabetes-related eye damage and improves your overall health.